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1.
Medicine (Baltimore) ; 100(10): e24030, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725816

RESUMO

ABSTRACT: The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Doenças da Medula Espinal/complicações , Medula Espinal/anormalidades , Anormalidades Múltiplas/epidemiologia , Adolescente , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/congênito , Escoliose/epidemiologia , Medula Espinal/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
BMC Neurol ; 21(1): 52, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535981

RESUMO

BACKGROUND: Isolated spinal artery aneurysms are extremely rare, and their pathogenesis, clinical presentation, and treatment strategies are poorly established. We report only the second case of a patient with an isolated posterior spinal aneurysm and concurrent left thalamic infarct and review the literature to help clarify treatment strategies of isolated spinal aneurysms. CASE PRESENTATION: A 49-year-old patient presented with acute onset walking difficulty followed by diaphoresis, back and abdominal pain, and paraplegia. Imaging was notable for a hemorrhagic spinal lesion with compression at T12 through L4 and an acute left thalamic infarct. Surgical exploration revealed an isolated posterior spinal artery aneurysm. The aneurysm was surgically resected and the patient had partial recovery six months post-operatively. CONCLUSIONS: Isolated posterior spinal artery aneurysms of the thoracolumbar region are rare lesions that commonly present with abdominal pain, radiating back pain, and lower extremity weakness. Imaging may not provide a definitive diagnosis. The three primary treatment strategies are conservative management, endovascular treatment, or surgical resection. In patients with symptomatic cord compression, immediate surgical intervention is indicated to preserve neurologic function. In all other cases, the artery size, distal flow, morphology, and location may guide management.


Assuntos
Aneurisma Roto/complicações , Infarto Cerebral/etiologia , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Artéria Vertebral/patologia , Aneurisma Roto/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Medula Espinal/cirurgia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
3.
Neurosurgery ; 88(3): 666-673, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33428765

RESUMO

BACKGROUND: Spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation and are distinct from spinal dural arteriovenous fistulas (SDAVFs). Differentiating between these 2 entities is important as operative strategies often differ based on angioarchitecture. OBJECTIVE: To compare demographic, clinical, anatomic, and imaging findings of SDAVFs and SEDAVFs. METHODS: Consecutive patients diagnosed and/or treated for SDAVF or SEDAVF at our institution between January 2000 and November 2018 were included. Data were collected on demographics, clinical presentation, and imaging findings. All cross-sectional and angiographic imaging were reviewed. To compare continuous variables, t-test was used Chi-squared was used for categorical variables. RESULTS: A total of 169 patients were included. In total 47 patients had SEDAVFs and 122 patients had SDVAFs. Clinical presentation and magnetic resonance imaging (MRI) imaging findings were similar between the 2 groups. SEDAVF patients were significantly more likely to have an epidural venous pouch on gadolinium bolus MR angiography (MRA) (0.0% vs 92.1%, P < .0001). SEDAVFs were more commonly located in the lumbar and sacral spine than SDAVFs (85.1% vs 34.4%, P < .0001). When in the lumbar spine, SEDAVFs unlike SDAVFs were more likely to involve the most caudal segments (L4 and L5, P = .02). CONCLUSION: SEDAVF share clinical and radiological findings similar to SDAVFS, including high T2 cord signal, cord enhancement, and perimedullary flow voids on conventional MRI. However, they have a characteristic appearance on spinal MRA and DSA with a pouch of epidural contrast. SEDAVFs are more commonly located in the lumbosacral spine.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Espaço Epidural/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Adulto , Idoso , Angiografia/métodos , Fístula Arteriovenosa/cirurgia , Fístula Arteriovenosa/terapia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Malformações Vasculares do Sistema Nervoso Central/terapia , Estudos Transversais , Procedimentos Endovasculares/métodos , Espaço Epidural/irrigação sanguínea , Espaço Epidural/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medula Espinal/irrigação sanguínea , Medula Espinal/cirurgia
4.
Medicine (Baltimore) ; 99(52): e23853, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350777

RESUMO

INTRODUCTION: The association of human immunodeficiency virus (HIV) infection with Burkitt lymphoma is related to the presence of Epstein Barr virus infection and the impact of the HIV antigen on the expansion of B-polyclonal cells. In Southeast Europe, the association is rare, and recognizing this is important in the therapeutic decision to increase patient survival rate. The association of HIV with Burkitt lymphoma and tuberculosis is even more rarely described in the literature. PATIENT CONCERNS: We present the case of a 40-year-old patient who presented with a 3-week history of fever (max. 38.7 °C), painful axillary swelling on the right side, lumbar pain, gait disorders, headache, and night sweats. Clinical manifestations included marked weight loss (about 30 kg in the last 2 months before his admission). DIAGNOSIS: A LyCD4 count of 38/µL and a HIV1 viral load of 384,000/mm3, classified the patient into a C3 stage. A biopsy of the right axillary lymph node was performed for suspected ganglionic tuberculosis due to immunodeficiency. Histopathological examination confirmed the diagnosis of Burkitt lymphoma. Cultures on Löwenstein-Jensen medium from sputum harvested at first admission were positive for Mycobacterium tuberculosis. INTERVENTIONS: Highly active antiretroviral therapy, chemotherapeutic agents for Burkitt lymphoma, anti-tuberculous drug therapy, neurosurgical intervention of spinal cord decompression, and antibiotic therapy of the associated bacterial infection. OUTCOME: Burkitt lymphoma disseminated rapidly, with central nervous system, spinal cord, osteomuscular, adrenal, and spleen involvement. The evolution under treatment was unfavorable, with patient death occurring 6 months after diagnosis. CONCLUSIONS: The association of HIV infection with Burkitt lymphoma and tuberculosis is rare in the highly active antiretroviral therapy (HAART) era, posing prompt and multidisciplinary therapeutic management issues. Similar cases of HIV-TB and Burkitt lymphoma association have been described, but none of the other cases showed the involvement of the central nervous system or of the bilateral adrenal glands.


Assuntos
Antineoplásicos/administração & dosagem , Terapia Antirretroviral de Alta Atividade/métodos , Antituberculosos/administração & dosagem , Encéfalo , Linfoma de Burkitt , Infecções por HIV , Medula Espinal , Tuberculose Pulmonar , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Linfoma de Burkitt/fisiopatologia , Linfoma de Burkitt/cirurgia , Contagem de Linfócito CD4/métodos , Deterioração Clínica , Descompressão Cirúrgica/métodos , Evolução Fatal , Infecções por HIV/sangue , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Medula Espinal/cirurgia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/fisiopatologia , Tuberculose Pulmonar/terapia , Carga Viral/métodos
5.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334744

RESUMO

Myxopapillary ependymoma (MPE) is a rare glial tumour mainly located in the areas of the conus medullaris, cauda equina and filum terminale of the spinal cord. Ectopic MPE tends to behave more aggressively and distant metastases are often seen. Unfortunately, no standard treatment options are established as only small series of treated patients and a few reported cases are available in the literature. We report the case of a 25-year-old woman who was initially diagnosed with a metastatic MPE, with multiple bilateral lung metastases. She was treated with an investigational monoclonal antibody antiprogrammed cell death protein 1, called tislelizumab (BGB-A317), following surgical resection of the perisacral primary mass. The response was long-lasting and side effects nil. Immunotherapy is a treatment modality to be considered in patients with rare tumours.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Drogas em Investigação/uso terapêutico , Ependimoma/terapia , Neoplasias Pulmonares/terapia , Neoplasias da Medula Espinal/terapia , Biópsia com Agulha de Grande Calibre , Quimioterapia Adjuvante/métodos , Ependimoma/complicações , Ependimoma/diagnóstico , Ependimoma/secundário , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Invasividade Neoplásica , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , Medula Espinal/patologia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
6.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334766

RESUMO

Radiation-induced spinal glioblastoma is an extremely rare disease with only four previously published reports in the literature. We report the fifth case, a 69-year-old woman who previously underwent treatment with brachytherapy for cervical cancer, and thereafter presented with neurologic deficits from a conus medullaris tumour. Biopsy and histopathology confirm glioblastoma, not otherwise specified. Treatment of spinal glioblastoma consists of surgery, either biopsy or excision and chemoradiation. However, results are still unsatisfactory and prognosis remains poor.


Assuntos
Braquiterapia/efeitos adversos , Glioblastoma/diagnóstico , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias da Medula Espinal/diagnóstico , Neoplasias do Colo do Útero/radioterapia , Idoso , Biópsia , Procedimentos Cirúrgicos de Citorredução , Feminino , Glioblastoma/etiologia , Glioblastoma/patologia , Glioblastoma/cirurgia , Humanos , Laminectomia , Imagem por Ressonância Magnética , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/cirurgia , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Medula Espinal/efeitos da radiação , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/etiologia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia
7.
Magy Seb ; 73(4): 153-159, 2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310918

RESUMO

Összefoglaló. A thoracoabdominalis aorta kirekesztése a gerincvelo keringésének csökkenését okozza. Az ischemia klinikailag paraparesis, paraplegia formájában jelenik meg. Ez elsosorban nyitott mutétek során jelent aligha kiszámítható szövodményt, de a modern endovascularis technikák sem oldották meg teljes mértékben ennek biztonságos kivédését - bár arányát jelentosen mérsékelték. A javuló eredmények számos tényezore vezethetok vissza, mint a keringés kirekesztési idejének csökkentése, a gerincvelo-funkció és metabolismus ellenorzése. Mesterséges keringésjavító direkt és indirekt eljárások, liquor drainage, hutés mellett a collateralis keringés javítását szolgáló prekondicionáló módszerek kerültek bevezetésre. Kísérletes munkánkban 25-30 kg testsúlyú kutyákon vizsgáltuk - más paraméterek mellett - a distalis perfusio növelésének, a liquornyomás csökkentésének, illetve ezek kombinációjának protektív hatását egyórás thoracoabdominalis aortakirekesztés során. Dolgozatunkban a kísérleti állataink neurológiai végállapotát a keringési paraméterek és szöveti perfusio és a reperfusio változásainak összefüggésein keresztül tárgyaljuk. Megállapítottuk, hogy distalis gerincvelo reperfusiós hyperaemiája szorosan összefügg a neurológiai károsodás mértékével. Summary. Clamping of the thoracoabdominal aorta reduces perfusion of the spinal cord significantly, which clinically may present as paraparesis or paraplegia - devastating and unpredictable complications of open thoracoabdominal aortic surgery. Introduction of monitoring of evoked potentials and/or biochemical markers, methods increasing distal arterial pressure, indirect procedures enhancing residual flow (like liquor drainage), drugs, and use of hypothermia contributed to achieve better outcome. Preconditioning of spinal cord circulation is also a promising method. New endovascular techniques for thoracoabdominal aortic aneurysms and dissections reduced surgical trauma significantly. Despite all these progressions spinal cord ischemic damage is still a significant risk. To address this problem we carried out an experimental work using a canine model focusing on the protective effect of distal arterial perfusion, spinal fluid drainage, and their combination in a one hour setting of thoracoabdominal aortic clamping. In this paper we publish our data of circulatory and specific perfusion parameters of the spinal cord during and after declamping in correlation of final neurologic outcome.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Paraplegia/complicações , Medula Espinal/cirurgia , Animais , Constrição , Cães , Perfusão , Medula Espinal/irrigação sanguínea
8.
Spinal Cord Ser Cases ; 6(1): 92, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999271

RESUMO

INTRODUCTION: We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. CASE PRESENTATION: We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). DISCUSSION: To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Medula Espinal/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia
9.
BMJ Case Rep ; 13(9)2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938652

RESUMO

The presence of a cerebrospinal fluid (CSF) shunt was previously considered a contra-indication to laparoscopic surgery, however, case reports appeared that describe laparoscopic surgery proceeding with no adverse outcomes in such patients. The majority of these reports relate to laparoscopic cholecystectomy. Here we present what we believe to be only the second report of a patient undergoing laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt. With this case we aim to add to the evidence that more major laparoscopic procedures can be performed safely in the presence of CSF shunts and with a brief review of the current evidence, have suggested appropriate monitoring and precautionary measures for approaching these procedures.


Assuntos
Derivações do Líquido Cefalorraquidiano , Laparoscopia , Peritônio/cirurgia , Medula Espinal/cirurgia , Adulto , Feminino , Humanos , Vértebras Lombares
10.
J Vis Exp ; (162)2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32925896

RESUMO

The goal of the presented protocol was to establish a detrusor underactivity (DU) model in the rat through conus medullaris transection. Laminectomy was performed in a total of 40 female Wistar rats (control group: 10 rats; test group: 30 rats) weighing 200-220 g, and the conus medullaris was transected at the L4‒L5 level in the test group. All the rats were housed and fed under the same environmental conditions for six weeks. In the test group, urine voiding was performed twice daily for six weeks, and mean residual urine volume was recorded. A cystometrogram was performed in both groups. Maximum cystometric capacity (MCC), detrusor opening pressure (DOP), and compliance of the bladder were recorded and calculated. The test group showed significant urinary retention after the surgery, both during and after the spinal shock. However, no abnormality was observed in the control group. When compared to the control group, the MCC and compliance of bladder in the test group was significantly higher than that of the test group (3.24 ± 2.261 mL versus 1.04 ± 0.571 mL; 0.43 ± 0.578 mL/cmH2O versus 0.032 ± 0.016 mL/cmH2O), whereas DOP in the test group was lower than control (20.28 ± 14.022 cmH2O versus 35 ± 13.258 cmH2O). This method of establishing an animal model of DU by the conus medullaris transection offers an excellent opportunity to understand DU's pathophysiology in a better manner.


Assuntos
Medula Espinal/cirurgia , Bexiga Inativa/etiologia , Animais , Modelos Animais de Doenças , Feminino , Ratos , Ratos Wistar , Bexiga Inativa/patologia
11.
Medicine (Baltimore) ; 99(32): e21579, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769906

RESUMO

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ±â€Š86 perfusion unite (PU), and the SCBF decreased to 228 ±â€Š68 PU after VCR (P = .008). The SCBF increased to 296 ±â€Š102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ±â€Š65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.


Assuntos
Cifose/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Escoliose/cirurgia , Medula Espinal/irrigação sanguínea , Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Cifose/complicações , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Escoliose/complicações , Medula Espinal/cirurgia , Coluna Vertebral/fisiopatologia , Resultado do Tratamento
12.
World Neurosurg ; 139: 592-602, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376383

RESUMO

BACKGROUND: Idiopathic ventral spinal cord herniation (ISCH) is a rare disease; however, it is an important differential diagnosis. Its treatment presents some controversies. CASE DESCRIPTION: We report on a 55-year-old woman who had been presenting with relevant back pain and leg weakness for the past 3 years and urinary incontinence for the past 3 months. Clinical examination disclosed paresis on the right inferior limb and right foot, as well as a T6-level painful hypoesthesia. Magnetic resonance imaging disclosed a T4/T5 ISCH. The patient underwent surgical decompression. During the procedure, we opened the arachnoid and cut the dentate ligaments of the spine, which considerably improved the mobility and safety of the procedure. In the early follow-up, our patient presented a partial improvement regarding the paresis grades and hypoesthesia pain relief on the left side. A video showing the surgical procedure and case evolution is presented. We also assembled literature reviews to compare our case with others. ISCH is becoming a more recognized cause of progressive thoracic myelopathy. However, this condition is still frequently misdiagnosed. Magnetic resonance imaging is the key for diagnosis. The objective of surgical treatment is to prevent myelopathy progression. The technique presented in this report is an appropriate surgical option, once it is a safer way to identify and treat the defect. The neurologic condition usually improves greatly after surgical treatment, especially when the patient presents positive predictive factors. CONCLUSIONS: ISCH is being more recognized. The technique presented is an appropriate surgical option.


Assuntos
Hérnia/diagnóstico por imagem , Herniorrafia/métodos , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
13.
J Clin Neurosci ; 77: 25-30, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451215

RESUMO

Spinal dural arteriovenous fistula (dAVF) is an extremely rare vascular entity that is usually misdiagnosed. We sought to determine the long-term clinical outcomes of patients undergoing microsurgical treatment for delayed diagnosis of spinal dAVF. This retrospective study identified patients with delayed diagnosed spinal dAVF at our institution from 2009 to 2018. Patients' data, including demographics, imaging, and follow-up data, were evaluated. This cohort included 65 consecutive patients with 68 dAVFs and a male-to-female ratio of 4:1 and a mean age of 53.5 ± 13.7 years. The presenting symptoms consisted of limb weakness (n = 42, 64.6%), paraparesis (n = 34, 52.3%), sphincter disturbances (n = 8, 12.3%), and pain (n = 13, 20.0%). The proportion of patients with each symptom significantly increased and patients experienced increased disability when the diagnosis was finalized. The mean length of delay of diagnosis was 20.7 ± 30.0 months. Surgery resulted in complete occlusion of the fistula on the first attempt in all patients. Three patients developed recurrent fistulas, and three died in the follow-up period. Improved motor function was achieved in 38 patients (59.5%). Other symptoms, such as sensory disorders, sphincter dysfunction, and pain, improved by 37.3%, 32.3%, and 66.7%, respectively. Patients with spinal dAVF usually exhibit progressive ascending myelopathy and often remain misdiagnosed for months to years. Some patients' increased disability cannot be reversed through surgery.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Tardio/tendências , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Dor/cirurgia , Paraparesia/diagnóstico por imagem , Paraparesia/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
14.
J Vis Exp ; (157)2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32281968

RESUMO

Incomplete spinal cord injury (SCI) often leads to impairments of sensorimotor functions and is clinically the most frequent type of SCI. Human Brown-Séquard syndrome is a common type of incomplete SCI caused by a lesion to one half of the spinal cord which results in paralysis and loss of proprioception on the same (or ipsilesional) side as the injury, and loss of pain and temperature sensation on the opposite (or contralesional) side. Adequate methodologies for producing a spinal cord lateral hemisection (HX) and assessing neurological impairments are essential to establish a reliable animal model of Brown-Séquard syndrome. Although lateral hemisection model plays a pivotal role in basic and translational research, standardized protocols for creating such a hemisection and assessing unilateralized function are lacking. The goal of this study is to describe step-by-step procedures to produce a rat spinal lateral HX at the 9th thoracic (T9) vertebral level. We, then, describe a combined behavior scale for HX (CBS-HX) that provides a simple and sensitive assessment of asymmetric neurological performance for unilateral SCI. The CBS-HX, ranging from 0 to 18, is composed of 4 individual assessments which include unilateral hindlimb stepping (UHS), coupling, contact placing, and grid walking. For CBS-HX, the ipsilateral and contralateral hindlimbs are assessed separately. We found that, after a T9 HX, the ipsilateral hindlimb showed impaired behavior function whereas the contralateral hindlimb showed substantial recovery. The CBS-HX effectively discriminated behavioral functions between ipsilateral and contralateral hindlimbs and detected temporal progression of recovery of the ipsilateral hindlimb. The CBS-HX components can be analyzed separately or in combination with other measures when needed. Although we only provided visual descriptions of the surgical procedures and behavioral assessments of a thoracic HX, the principle may be applied to other incomplete SCIs and at other levels of the injury.


Assuntos
Traumatismos da Medula Espinal/fisiopatologia , Medula Espinal/cirurgia , Animais , Comportamento Animal , Modelos Animais de Doenças , Masculino , Ratos , Medula Espinal/patologia
15.
World Neurosurg ; 138: 404-407, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251830

RESUMO

BACKGROUND: Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations; they frequently cause progressive myelopathy including gait disturbances and sensory disorders. CASE DESCRIPTION: We report a rare case of a middle-aged man who experienced right-sided chest pain and Th4 radiculopathy, without any other neurologic presentations. Magnetic resonance imaging showed a flow void sign on the dorsal aspect of the spinal cord; spinal angiography revealed an arteriovenous shunt between a radicular artery and an intradural vein. Suspecting SDAVF as the cause of the chest pain, we performed surgical resection. Intraoperatively, we observed compression of the rootlet by the draining vein. Right chest pain disappeared completely after obliteration of the SDAVF. The present patient had vascular compression of the spinal nerve rootlet without any venous congestion. CONCLUSIONS: Our experience shows that SDAVF can present not only as a myelopathy but also as a radiculopathy, indicating that radiculopathy may become a main symptom of SDAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Radiculopatia/etiologia , Medula Espinal/patologia , Medula Espinal/cirurgia , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Edema , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal , Vértebras Torácicas
16.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 76-86, mar.-abr. 2020. ilus, grab, tab
Artigo em Inglês | IBECS | ID: ibc-190375

RESUMO

INTRODUCTION AND OBJECTIVES: Angiolipomas of the spinal canal are a rare condition of unknown origin. They are considered histologically benign; however, some have the potential to infiltrate adjacent structures. The aim of this systematic review was to suggest a potential mechanism for the pathogenesis of spinal angiolipomas, along with a useful approach for their preoperative management. MATERIALS AND METHODS: A literature review of cases of spinal angiolipoma was performed. In addition, two of the cases encountered in our practice are presented. The first case refers to a 35-year-old male patient with a history of spinal fusion because of a T9 fracture, while the second concerns a 46-year-old male patient with an epidural mass extending outside the spinal canal, who underwent fine needle biopsy and embolisation of its feeding vessel. RESULTS: From the review of the literature performed, we were unable to identify any correlation between the infiltrative potential and the patients' demographic and tumour characteristics. CONCLUSIONS: Angiolipomas are considered to be sporadic, yet theories concerning their pathogenesis include reaction to harmful stimuli and congenital malformation of the adipose tissue. Fine needle biopsy may be mistakenly considered non-diagnostic, due to the presence of well-differentiated adipocytes


INTRODUCCIÓN Y OBJETIVOS: Los angiolipomas del canal vertebral son una enfermedad rara de origen desconocido. Se consideran histológicamente benignos, aunque en algunos casos existe la posibilidad de que se infiltren en estructuras adyacentes. El objetivo de esta revisión sistemática es sugerir un posible mecanismo para la patogenia de los angiolipomas espinales, junto con un enfoque útil para su tratamiento preoperatorio. Materiales y métodos: Se realizó una búsqueda bibliográfica de los casos de angiolipomas espinales. Además, se presentan 2 de los casos encontrados en nuestra práctica clínica. El primer caso corresponde a un paciente varón de 35 años con antecedentes de artrodesis vertebral debido a una fractura en T9, mientras que el segundo corresponde a un paciente varón de 46 años con una masa epidural que se extendía fuera del canal vertebral, al que se realizó una biopsia con aguja fina y una embolización del vaso nutricio. RESULTADOS: A partir de la revisión bibliográfica realizada, no pudimos identificar ninguna correlación entre el potencial de infiltración, los datos demográficos y las características de los tumores de los pacientes. CONCLUSIONES: Los angiolipomas se consideran esporádicos, existiendo, no obstante, teorías referentes a su patogenia que incluyen la reacción a estímulos nocivos y la malformación congénita del tejido adiposo. La biopsia con aguja fina puede considerarse erróneamente como no diagnóstica, debido a la presencia de adipocitos bien diferenciados


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Angiolipoma/cirurgia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/cirurgia , Angiolipoma/diagnóstico por imagem , Biópsia , Embolização Terapêutica , Tomografia Computadorizada por Raios X , Espectroscopia de Ressonância Magnética , Meios de Contraste , Fotomicrografia , Medula Espinal/patologia , Diagnóstico Diferencial , Neoplasias da Medula Espinal/diagnóstico por imagem
18.
World Neurosurg ; 137: e634-e641, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32112934

RESUMO

BACKGROUND: Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. METHODS: Six female juvenile pigs underwent surgical investigation. One control animal underwent a laminectomy only, whereas the 5 other animals had implantation of an intradural SCS prototype. One of the prototypes was fully wired to enable acute stimulation and concurrent electromyographic recordings. All animals underwent terminal surgery 3 months postimplantation, with harvesting of the spinal column. Imaging (microcomputed tomography scan) and histopathologic examinations were subsequently performed. RESULTS: All animals survived implantation without evidence of neurologic deficits or infection. Postmortem imaging and histopathologic examination of the spinal column revealed no evidence of spinal cord damage, cerebrospinal fluid fistula formation, abnormal bony overgrowth, or dural defect. Viable dura was present between the intra- and extradural plates of the device. Electromyographic recordings revealed evoked motor units from the stimulator. CONCLUSIONS: Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.


Assuntos
Terapia por Estimulação Elétrica/métodos , Neuroestimuladores Implantáveis , Dor Lombar/terapia , Medula Espinal/cirurgia , Animais , Feminino , Laminectomia , Suínos
19.
Rev. esp. med. legal ; 46(1): 20-27, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193986

RESUMO

El objetivo de la monitorización neurofisiológica intraoperatoria es la detección de daño o alteración funcional en el sistema nervioso lo más precozmente posible, asegurando la funcionalidad medular, evitando las complicaciones neurológicas. Sin embargo, la falta de estandarización en la metodología, junto con cierta inconsistencia en los estudios sobre su utilidad, limita el establecimiento de unas recomendaciones universales para su utilización. El presente trabajo pretende revisar los procedimientos de monitorización neurofisiológica, sus fortalezas y debilidades, así como la conveniencia de su empleo en cirugía espinal. Concluimos que, con carácter general, su falta de uso en dicha cirugía no contraviene la «lex artis», pues no existe evidencia de que pueda ayudar en revertir el daño neurológico. Sin embargo, puede emplearse como elemento de prueba tanto para detectar el momento y el tipo de daño neurológico como para aumentar la defensibilidad. Se requieren protocolos de uso, bien por las sociedades científicas o por los propios centros hospitalarios


The purpose of neurophysiological monitoring during surgery is to identify damage or functional neurological disturbances as soon as possible, ensuring spinal cord functionality and avoiding neurological complications. However, the lack of standardisation of the methodology, together with some inconsistencies in the studies on its usefulness, limit the establishment of universal recommendations for its use. The present paper intends to review neurophysiological monitoring procedures during surgery, including their strength and weaknesses, as well as to assess the convenience of their use during spinal surgery. It is concluded that, in general, the lack of its use in this surgery does not legally contravene the standard of care, as there is no evidence it could result in reverting neurological damage. Nevertheless, it can be used as evidence both in detecting the time and kind of neurological injury, and for increasing the defensibility. Protocols of use, provided either by scientific societies or hospitals themselves, are required


Assuntos
Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Imperícia/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Complicações Intraoperatórias/diagnóstico por imagem , Seguro de Responsabilidade Civil/tendências , Medula Espinal/cirurgia
20.
World Neurosurg ; 137: 235-238, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32081826

RESUMO

BACKGROUND: Subependymoma in the spinal cord is very rare and usually occurs in the cervical cord. We report an exceptional case of subependymoma that occurred at the conus medullaris with cystic formation. This article reviews the literature on subependymoma in the conus medullaris; discusses its clinical manifestations, imaging findings, and differential diagnoses; and offers an opinion about the cystic formation of the subependymoma. CASE DESCRIPTION: A 69-year-old woman experienced progressive limb weakness with a somatosensory abnormality for 3 months. Preoperative magnetic resonance imaging showed a cystic intramedullary lesion at the conus medullaris with a well-defined margin. A preliminary diagnosis of epidermoid cyst was made based on the imaging findings. During the operation, cystic formation of the tumor was found, and the tumor was completely removed. Pathology showed an uneven proliferation of glial cells, consistent with subependymal morphology, and the tumor was confirmed as subependymoma. CONCLUSIONS: We present an extremely rare case of cystic formation in subependymoma at the conus medullaris. Subependymoma should be included in the differential diagnosis of intramedullary cystic lesions. The breakdown of the blood-brain barrier and excessive extravasation may be potential mechanisms of cystic formation.


Assuntos
Glioma Subependimal/cirurgia , Neoplasias da Medula Espinal/cirurgia , Medula Espinal/patologia , Medula Espinal/cirurgia , Idoso , Barreira Hematoencefálica/diagnóstico por imagem , Barreira Hematoencefálica/patologia , Diagnóstico Diferencial , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Feminino , Glioma Subependimal/diagnóstico por imagem , Glioma Subependimal/patologia , Humanos , Imagem por Ressonância Magnética , Neuroglia/patologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/patologia
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